Healthcare Provider Details

I. General information

NPI: 1992995344
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 NW 9TH ST SUITE 220
OKLAHOMA CITY OK
73102-1070
US

IV. Provider business mailing address

PO BOX 268986
OKLAHOMA CITY OK
73126-8986
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-8498
  • Fax: 405-272-8425
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: INSURANCE CREDENTIALING SPECIALIST
Credential:
Phone: 405-272-7452